Provider Demographics
NPI:1457667693
Name:MOUROUX, BRADLEY GENE (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:GENE
Last Name:MOUROUX
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 BOLINAS RD
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1659
Mailing Address - Country:US
Mailing Address - Phone:415-472-7316
Mailing Address - Fax:
Practice Address - Street 1:1888 SARATOGA AVE
Practice Address - Street 2:STE 101
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-5214
Practice Address - Country:US
Practice Address - Phone:415-472-7316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31651111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor